Abstract
Chinese mind-body exercises (CMBEs) are positively associated with executive function (EF), but their effects on EF, from synthesized evidence using systematic and meta-analytic reviews, have not been conducted. Therefore, the present systematic review with meta-analysis attempted to determine whether CMBEs affect EF and its sub-domains, as well as how exercise, sample, and study characteristics moderate the causal relationship between CMBEs and EF in middle-aged and older adults. Seven electronic databases were searched for relevant studies published from the inception of each database through June 2020 (PubMed, Web of Science, Embase, Cochrane Controlled Trials Register, Wanfang, China National Knowledge Infrastructure, and Weipu). Randomized controlled trials with at least one outcome measure of CMBEs on EF in adults of mean age ≥ 50 years with intact cognition or mild cognitive impairment (MCI) and with or without chronic diseases were included. A total of 29 studies (N = 2,934) ultimately were included in this study. The results indicated that CMBEs improved overall EF (Standardized Mean Differences = 0.28, 95% CI 0.12, 0.44), as well as its sub-domains of working memory and shifting. The beneficial effects of CMBEs on EF occurred regardless of type (Tai Chi, Qigong), frequency of group classes (≤2 time, 3-4 time, ≥5 times), session time (≤45 min, 46-60 min), total training time (≥150 to ≤300 min, >300 min), and length of the CMBEs (4-12 week, 13-26 week, and >26 week), in addition to that more frequent participation in both group classes and home practice sessions (≥5 times per week) resulted in more beneficial effects. The positive effects of CMBEs on EF were also demonstrated, regardless of participants mean age (50-65 years old, >65 years old), sex (only female, both), and cognitive statuses (normal, MCI, not mentioned), health status (with chronic disease, without chronic disease), as well as training mode (group class, group class plus home practice) and study language (English, Chinese). This review thus suggests that CMBEs can be used as an effective method with small to moderate and positive effects in enhancing EF, and that more frequent group classes and home practice sessions may increase these effects. However, certain limitations, including strictly design studies, limited ES (effect size) samples for specific variables, and possible biased publications, required paying particular attention to, for further exploring the effects of CMBEs on EF.
Highlights
As people grow older, they are susceptible to decline in executive function (EF) (Zaninotto et al, 2018; Caballero et al, 2020)
In terms of control groups, the results indicated that the effects of Chinese mind-body exercises (CMBEs) on EF were significantly influenced by control groups (p = 0.018)
The positive effect of CMBEs on EF was found to be influenced by the frequency of group classes or group classes plus home practice sessions, as well as by the control groups selected for exercise and study characteristics, respectively
Summary
They are susceptible to decline in executive function (EF) (Zaninotto et al, 2018; Caballero et al, 2020). Despite that Tai Chi has shown benefits compared to other single forms of exercise (e.g., aerobic exercise and resistance exercise) (Northey et al, 2018; Chen et al, 2020a), these studies have either focused on an overall EF with a small number of RCT studies (k =4) (Wayne et al, 2014) or a specific EF sub-domain with a limited number of RCT and Non-RCT studies (k =2-5) without considering core EF and higher-level EF in particular (Wu et al, 2013; Zheng et al, 2015). Some studies have shown that Tai Chi had evidenced no improvements on EF in older adults (Hall et al, 2009; Gerritsen et al, 2020) Such various results suggest that a comprehensive understanding of the effects of CMBEs on EF is still lacking
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